J. Atahar1, J. Hayward1, A. Halpern1, A. Noureldin1, S. Kartiko1 1George Washington University School Of Medicine And Health Sciences, Surgery, Washington, DC, USA
Introduction:
Delirium is a common finding in ICU patients with traumatic brain injuries (TBI), worsening their outcomes. Most patients with TBI require hourly neurological exams (Q1 neuro checks) which is a common source of sleep disruption, increasing their likelihood of delirium. To reduce the rate of delirium in our TBI patients, we introduced a change in practice where we automatically changed our neurochecks from every hour to every two hours after 24 hours of hospitalization, unless specifically recommended not to by our neurosurgical colleagues.
Methods:
We performed a single-institution retrospective chart review of 178 patients diagnosed with TBI who were admitted to the ICU and underwent Q1 neuro checks at a level-one trauma center. We placed patients into two groups based on whether they underwent Q1 neuro checks for less than 24 hours (n=100) or more than 24 hours (n=78). Minors and patients who had a catastrophic brain injury incompatible with life were excluded. We used univariate and multivariate analysis to evaluate the association between duration of Q1 neuro checks and delirium. We used a survival model to analyze secondary outcomes, which included return to the operating room for neurosurgical causes, re-admission to the ICU, re-bleed, other complications, and death.
Results:
On univariate analysis, rates of delirium between the group who underwent Q1 neuro checks for less than 24 hours and the Q1 neuro checks for more than 24 hours group had a non-statistically significant difference at 8% and 16.67%, respectively (p=0.08). On multivariate analysis, after controlling for patient demographics, ICU and hospital LOS, injury status, ventilation requirement, and complications, patients undergoing Q1 neuro checks for more than 24 hours had a statistically significant increased risk of delirium (p=0.02). There were no unplanned trips to the OR for a neurosurgical cause in either group. There was no significant difference in complications between the two groups (p=0.56). Survival was higher in patients undergoing Q1 neuro checks for less than 24 hours, but this was not statistically significant (p=0.61).
Conclusion:
Our study found that patients undergoing Q1 neuro checks for less time had a lower incidence of delirium without increased complications. Further studies with a larger patient population are needed to confirm these results